Meena Satya Prakash, Badkur Mayank, Rodha Mahaveer S, Lodha Mahendra, Puranik Ashok, Premi Krashan Kant
Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Trauma and Emergency (General Surgery), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Family Med Prim Care. 2022 Feb;11(2):581-586. doi: 10.4103/jfmpc.jfmpc_1196_21. Epub 2022 Feb 16.
Appendectomy is the most commonly performed surgery in the emergency department. It is very difficult to determine the minimal duration of the learning curve for junior residents to perform safe laparoscopic surgeries.
This study aimed to determine the feasibility of a safe laparoscopic appendectomy performed by junior residents.
A retrospective study was conducted at a tertiary healthcare center from May 2018 to May 2020.
This study reviewed all the data of laparoscopic appendectomy performed by junior and senior residents. Both groups were compared for the patient outcome in terms of complications, conversion to open, intraoperative findings, operative time, postoperative progress, and hospital stay.
The data were formulated in an excel sheet and analyzed with SPSS. Mean, median, range, standard deviation, percentages, univariate analysis with χ test and test were used.
No significant difference was found in operative time (mean [SD], 84.87 [24.73] vs. 86.95 [24.93], = 0.679), intraoperative complication (9.2% vs. 7.8%, = 0.769), postoperative complications (34.2% vs. 34.4%, = 0.984), conversion to open (6.6% vs. 4.7%, = 0.633), length of postoperative hospital stay (Mean [SD], 2.3 [2] vs. 2.2 [1], = 0.739), and readmission (4% vs. 3%, = 0.794). No major intraoperative complications and mortality were found in both groups.
Junior residents may be allowed for safe laparoscopic appendectomy under supervision without experience of open appendectomy. The patient's outcomes may be comparable with surgery performed by well-experienced surgeons. They can improve the basic healthcare system in the future with feasible basic laparoscopic surgery for common diseases.
阑尾切除术是急诊科最常开展的手术。确定初级住院医师进行安全的腹腔镜手术所需学习曲线的最短时长非常困难。
本研究旨在确定初级住院医师进行安全的腹腔镜阑尾切除术的可行性。
于2018年5月至2020年5月在一家三级医疗中心开展了一项回顾性研究。
本研究回顾了初级和高级住院医师进行腹腔镜阑尾切除术的所有数据。比较了两组患者在并发症、转为开腹手术、术中发现、手术时间、术后恢复情况及住院时间方面的结局。
数据录入电子表格并用SPSS进行分析。采用均值、中位数、范围、标准差、百分比，以及χ检验和t检验进行单因素分析。
手术时间（均值[标准差]，84.87[24.73]对86.95[24.93]，P = 0.679）、术中并发症（9.2%对7.8%，P = 0.769）、术后并发症（34.2%对34.4%，P = 0.984）、转为开腹手术（6.6%对4.7%，P = 0.633）、术后住院时长（均值[标准差]，2.3[2]对2.2[1]，P = 0.739）及再次入院率（4%对3%，P = 0.794）方面均未发现显著差异。两组均未出现重大术中并发症及死亡情况。
在没有开腹阑尾切除术经验的情况下，初级住院医师在监督下也可进行安全的腹腔镜阑尾切除术。患者的结局可能与经验丰富的外科医生进行的手术相当。他们未来可以通过开展可行的常见疾病基础腹腔镜手术来改善基层医疗体系。
